The European Medicines Agency has approved the powerful new opioid Dsuvia, and FDA head Gottlieb made the right choice in following suit, Sen. Markey and Public Citizen notwithstanding [Jeffrey Singer, Cato]

“Your doctors didn’t jump out of business; they were pushed. And they were pushed by people way too convinced of their qualifications to redesign the world around them.” [J.D. Tuccille, Reason]

Last week the Washington Post flayed doctors who participate in the Medicare program, along with the pharmaceutical company Genentech, because they often prescribe the $2,000-a-dose (and fully FDA-approved) eye drug Lucentis in preference to Avastin, a biologically related compound also made by Genentech that seems to work equally well against “wet” age-related macular degeneration and can be obtained off-label from compounders for only $50 an injection (albeit with some additional risks and hassles). Taxpayers have shelled out billions of dollars, the Post complains with some justice, because many docs (currently close to half) choose FDA-approved in preference to off-label treatments.

Great investigation, guys. Now that you’ve accused doctors of being socially irresponsible and greedy for not going off-label to prescribe, could you investigate who exactly has been demonizingoff-labelprescribing as a dangerous, unregulated practice that the FDA needs to crack down on? What would happen if you found that that it was some of the Post’s own favorite sources and advocacy groups?

Most of the costs in the U.S. health-care system are incurred in a small number of expensive cases. The top 25 percent of Medicare beneficiaries ranked by cost, for example, account for 85 percent of total spending. And the expenses in those cases are driven significantly by the recommendations that doctors make to pursue one treatment path and not another.

In making these choices, doctors are influenced by various things, including medical-school training, traditions among their peers, financial incentives (which are distorted by fee- for-service payments) and, yes, the medical-malpractice system. Improving the criteria for what constitutes appropriate care could significantly change doctors’ behavior and also save money, recent research by Michael Frakes of Cornell Law School suggests.

Continuing the discussion of electronic medical records from a few days back: as medico-legal documents, EMRs are under pressure to be something other than candid and spontaneous [Kaus] While other patients wait for critical care, ER docs and nurses enter mandatory data fields for whether the infant is a smoker or the flu victim is a fall risk [White Coat]